Provider Demographics
NPI:1790090009
Name:CIOCCO, LINDSAY T (OD)
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:T
Last Name:CIOCCO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LINDSAY
Other - Middle Name:T
Other - Last Name:GIBNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1106 ANNAPOLIS RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1637
Mailing Address - Country:US
Mailing Address - Phone:410-874-1425
Mailing Address - Fax:410-874-1429
Practice Address - Street 1:1106 ANNAPOLIS RD
Practice Address - Street 2:SUITE 290
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1637
Practice Address - Country:US
Practice Address - Phone:410-874-1425
Practice Address - Fax:410-874-1429
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2298152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist